Three of the trials compared the deep infection rates between the staples group and the sutures group. Seven out of 491 patients in the staples group were infected, while 4 out of 527 patients in the sutures group were infected. The fixed-effects meta-analysis of the 6 trials showed that the risk of deep infection was higher with staples than with sutures for skin closure after hip arthroplasty. The odds ratio of deep infection was 1.70 (95% CI 0.56–5.21; P = 0.35), and there was no heterogeneity (χ2 = 1.67; I2 = 0%; P = 0.43). The forest plots are illustrated in Fig. 5. Similarly, we further compared the deep infection rates between staples and sutures for skin closure after total hip arthroplasty. Data regarding deep infection after total hip arthroplasty were reported in four studies [11, 12, 27, 28]. After total hip arthroplasty, 5 out of 380 patients in the staples group were infected, while 4 out of 386 patients were infected in the sutures group. The fixed-effects meta-analysis showed that the risk of deep infection was higher with staples than with sutures for skin closure after total hip arthroplasty, with an OR (odds ratio) of 1.24 (95% CI 0.35–4.35; P = 0.74) and no heterogeneity (χ2 = 0.76; I2 = 0%; P = 0.38). The forest plot is illustrated in Fig. 6.
Fig. 5Forest plot for deep infection rate after hip arthroplasty
Full size image
Fig. 6Forest plot for deep infection rate after total hip arthroplasty
Full size image
Overall, 5 studies [6, 11, 13, 27, 28] reported on discharge after hip arthroplasty. Wound discharge lasting at least 4 days was recorded as ‘prolonged discharge’ in these studies; 55 out of 544 patients in the staples groups had prolonged discharge, while 21 out of 577 patients in the sutures groups had prolonged discharge. The fixed-effects meta-analysis of all 5 trials revealed that the risk of prolonged discharge was lower with sutures than with staples for skin closure after hip arthroplasty. The odds ratio of prolonged discharge was 2.88 (95% CI, 1.72 to 4.83; P < 0.0001), and there was no heterogeneity (χ2 = 1.48; I2 = 0%; P = 0.83). The forest plot is listed in Fig. 7.
Fig. 7Forest plot for prolonged discharge
Full size image
Two studies [13, 27] compared the number of participants who developed wound abscesses after hip arthroplasty. From a total of 321 patients, only one patient from the sutures group developed an abscess. The OR-based models revealed that the incidence of abscesses was similar between skin staples and sutures (OR = 0.30; 95% CI 0.01–7.54; P = 0.46), with no heterogeneity. The forest plots are illustrated in Fig. 8.
Fig. 8Forest plot for abscess, wound dehiscence, allergic reaction
Full size image
Three studies [12, 13, 28] reported data on wound dehiscence. Four out of 462 patients in the staples group experienced wound dehiscence, while 2 out of 499 patients in the sutures group experienced wound dehiscence. The fixed-effects meta-analysis of 3 trials revealed that there was no significant difference in the risk of wound dehiscence between the two groups after hip arthroplasty (OR = 0.42; 95% CI 0.02–10.41; P = 0.60), with no heterogeneity. The forest plots are illustrated in Fig. 8.
Two trials [11, 27] reported allergic reactions. Two out of 300 patients had allergic reactions, and our findings showed that there was no significant difference in the risk of allergic reaction between the staples groups and the sutures groups after hip arthroplasty (OR = 0.39; 95% CI 0.09–1.69; P = 0.21; heterogeneity: χ2 = 0.03, P = 0.86, I2 = 0%). The forest plots are illustrated in Fig. 8.
A total of two trials [6, 13] reported inflammation. In the staples groups, there were signs of inflammation in 12 out of 128 participants, while in the sutures groups there were only seven out of 158 participants with signs of inflammation. However, our pooled result revealed that the differences noted between the staples group and sutures group were not statistically significant (OR = 3.78; 95% CI 0.05–317.93; P = 0.56; heterogeneity: χ2 = 7.43, P = 0.006, I2 = 87%). Because the heterogeneity was more than 50%, we chose the fixed-effects model. In addition, there are no additional data to support our further sensitivity or subgroup analysis. The forest plots are illustrated in Fig. 9.
Fig. 9Forest plot for inflammation
Full size image
In addition to the six outcomes assessed in our study, four other secondary outcomes (length of stay, Holland Wound Evaluation Score, closure time, and visual analogue score) were compared in the systematic review section of this study. The included trials did not provide appropriate data types to conduct a meta-analysis.
Two studies reported the time required for wound closure. Khan et al. [27] and Rui et al. [12] both showed that wound closure with staples was significantly faster than with sutures. The data on wound closure time with staples or sutures are listed in Table 4.
Table 4 Closure time, LOS, HWES, VASFull size table
Three studies indicated the length of stay in the hospital for wound closure with skin staples or sutures after hip arthroplasty. Khan et al. [27] and Lu et al. [13] both showed that there were no significant differences in the median length of stay in the hospital. However, Rui et al. [12] reported the length of stay in the hospital in the staples group compared with the sutures group. The median and interquartile ranges of length of stay in the hospital are listed in Table 4.
The HWES is a scoring rule to evaluate surgical wounds and predict wound healing. The HWES evaluates the wound for steps, irregular contour, edge separation, edge inversion, excessive deformation and overall appearance. Each category is graded with a score of 0 or 1. The total score is 0–6, and wounds with a score of 6 have the best prognosis. Two studies used the Hollander Wound Evaluation Score to evaluate wounds after hip arthroplasty. In the two studies [12, 27], the HWES of the staples groups was lower than that of the sutures groups, but there was no significant difference in Holland's wound evaluation score. The Hollander Wound Evaluation Scores are listed in Table 4.
Two studies [12, 27] used the visual analogue scale (VAS) to evaluate the satisfaction of patients according to skin wound closure methods. The study by Khan et al. judged patient satisfaction with skin closure technology with a VAS score between 0 and 100, of which 100 denotes the greatest satisfaction, while Rui, M et al. assessed patient satisfaction with a VAS score between 0 and 10, with 10 denoting the greatest satisfaction. Both of these studies reported that there was no significant difference between the satisfaction of patients in the staples group and those in the sutures group after hip arthroplasty. The Visual Analogue Scale (VAS) scores are listed in Table 4.
For more information Benefits of Surgical Staples than Stitches, please get in touch with us!